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The Malvern Advantage 401(k)
Proposal Request Form

	Type:
	Employer Information
	Employer Legal Name:
	Type of Business:
	Address
	City / State / Zip:
	Employer Domicile State:
	Contact:
	Title:
	Phone:
	Fax:
	E-mail:
	Is this a Multiple Employer?
	Does Employer maintain ownership in any other corporation or business?
	Any other retirement plans? If yes, describe:
	Self-Directed Brokerage Accounts on current?
	Include with this proposal?

	Is this for a new or takeover plan?
	Eligible/Participating Employees:	/
	Estimated employee contributions:	$
	Estimated matching contributions:	$
	Estimated employer contributions:	$

	If Takeover Plan, Complete the following:
	Estimated takeover assets:	$
	Estimated conversion assets:	$
	Are takeover assets subject to penalties?
	Estimated amount:	$
	Current Investment Provider:
	Current Record Keeper:
	Is the current Plan a Prototype Plan Document?

	Financial Advisor Information
	Advisor Name:
	Firm Name:
	Address:
	City / State / Zip:
	Phone:
	Fax:
	E-mail Address:
	Broker / Dealer:


	Provide the current menu and the amount in each fund:

	Will the current funds be replaced? If yes, which funds might be used?

	What fees are currently paid by the employer?

	Is the payroll processed internally or externally? If externally, who does the payroll?

	How frequently are contributions submitted to be invested?

	Is there an employer match?

	Is the matching contribution deposited at the same time as the employee contributions?

	Is there a profit sharing or any other employee contribution?

	Are there any special needs?

	What is the expected date for taking over the plan?